The management of behavioural problems associated with dementia in rural aged care

In Australia 60-80% of all residents in aged care facilities have a cognitive impairment related to dementia with this figure predicted to increase. The associated behavioural and psychological disorders associated with dementia frequently result in the prescription of antipsychotic drugs to assist in limiting disruptive or concerning unmet needs behaviour. Antipsychotic prescription rates in aged care facilities are estimated to be as high as 80% despite the well known adverse effects in this population. Person centred care approaches to management of behavioural and psychological symptoms of dementia (BPSD) has not been widely implemented despite its reported effectiveness. Other interventions aimed at reducing antipsychotic use in aged care has been limited and the barriers to the use of non pharmacological strategies are poorly researched.

In this study a 43 point questionnaire was distributed to 6 rural aged care facilities to assess nurses' knowledge of non pharmacological and pharmacological interventions, and the frequency, perceived barriers and efficacy of both strategies. Resources and information bases utilised in behaviour management was also explored.

The results indicated that staff have a good knowledge of possible underlying causes of BPSD, but a poor understanding of appropriate methods of management and resources available to assist them. Time constraints were frequently cited by respondents as problematic in managing behavioural problems. The results of this study suggest the need for utilisation of tools to assist nurses to identify target behaviours, implementation of appropriate management and access to the resources available.